Traumatic subhyaloid macular hemorrhage with complete resolution following Neodymium-Doped Yttrium Aluminium Garnet Laser

Abstract

PurposeTo report a case of traumatic subhyaloid macular hemorrhage with severe sudden vision loss treated successfully with Neodymium-Doped Yttrium Aluminium Garnet Laser (Nd:YAG laser).ObservationsA 16-year-old boy presented to the eye clinic with acute vision loss secondary to blunt trauma by a stone to his left eye 3 days prior to consultation that caused subhyaloid macular hemorrhage. Nd:YAG laser was performed to open the hyaloid membrane and allow the blood to diffuse into the vitreous cavity and be absorbed. The patient demonstrated complete recovery as his visual acuity went from counting fingers to 20/20 within 20 days. No complications due to the treatment were reported.Conclusions and importanceTo the best of our knowledge, there have been no reported cases of subhyaloid macular hemorrhage treated with Nd:YAG laser in which the etiology was trauma and showed full, rapid recovery with no sequelae.

Nd:YAG laser therapy for non-resolving premacular subhyaloid hemorrhage in Saudi patients

“…However, substandard VA in 50% of our cases resulted from an additional macular pathology due to diabetic retinopathy or CRVO. This is in keeping with several reports of favourable visual and anatomic results of the procedure in other populations [1], [2], [3], [4], [5], [6], [7], [8], [9], [10]. Khan showed a total of 11 out of 12 patients who underwent Nd-YAG had visual acuity improvement 16 .…”

“…It aims to drain the trapped blood into the vitreous cavity by creating a puncture in the posterior hyaloid membrane and/ or ILM by using the photo-disruptive effect of YAG laser. Some previous studies reported favourable outcomes of NYPH in cases of PMSHH [1], [2], [3], [4], [5], [6], [7], [8], [9], [10]. We noticed that many retina specialists do vitrectomy surgery as a primary intervention for the condition.…”

“…Intervention in a timely manner is crucial to maximize the chance of success of the YAG displacement while the blood is still in its liquid form ensuring flowability through the posterior hyaloid opening. When the blood becomes clotted with time, the chances of it clearing out through the opening become less, and the need to do vitrectomy increases 2 . We recommend applying NYPH for PMSHH if it does not show signs of spontaneous resolution in 2 weeks.…”

“…Premacular subhyaloid haemorrhage (PMSHH) is not an uncommon cause for sudden loss of vision that is associated with localized accumulation of blood in the subhyaloid space at the macular region. It can happen due to various causes including Valsalva retinopathy, 1 trauma, 2 proliferative diabetic retinopathy (PDR), retinal vein occlusion (RVO), 4 retinal arterial macro aneurysms, 5 hematologic disorders, 6 Terson syndrome, 7 and Eales’ disease 8 among others. The haemorrhage is usually dome shaped, circumscribed in appearance that can be under the internal limiting membrane (ILM) (sub-ILM) or between the ILM and the posterior hyaloid (subhyaloid).…”

Subinternal Limiting Membrane Hemorrhage Related to Laser Exposure in 2 Young Patients

“…YAG laser hyaloidotomy for the treatment of sub-ILM hemorrhage was described in the literature, [8][9][10] and in certain cases, it has shown its effectiveness.…”